Unethical Practices in Hair Transplantation

Unfortunately, there are several unethical practices in hair transplantation in today’s world. At Venkat Center, we strive to provide proper information to patients so that they can make the best decision.

Surgeries performed by technicians and assistants

Assistants and technicians are a vital component of Hair Transplant(HT), which is a teamwork. The entire surgery is a number of small steps held together by the lead surgeon. Of late, it has been reported that freelancing technicians move from clinic to clinic, visiting other clinics run by doctors, to perform HT. The concerned doctor usually is not a surgeon and may not participate in surgery in any way.

Entire surgery is performed by technicians. This is deplorable, unacceptable, risky, and should be stopped at once; assistants can only perform the dissection, arrangement of grafts, and implantation under supervision. They should not do extraction, incision, anesthesia or site creation. They should not do anything independently. Patients, therefore are advised to check with the assisting team.

At our center, we have a team of eight qualified nurses who have been trained specifically- they have been with us for a long time, some of them since the inception of the clinic -in fact, 3 of these nurses were trained by a team of nurses from Israel along with Dr. Alex Ginzburg in 2003!

Surgeries are being done by a person other than the one whom the patient consults.

This happens often in corporate chains and some clinic which don’t have an HT surgeon- the surgeon flies in from another city on the day of surgery, and consultation is done by another person- often a technician or an MBA. The surgeon flies out the same day after surgery and hence won’t be available for postsurgical consultation. This is not acceptable. Patients should insist on prior consultation with the operating surgeon- and insist that the same person does the surgery and is available for postsurgical consultation.

At our center, both Dr. Venkat and Dr. Aniketh are available before, during and after surgery at all times.

What should be the training needed for performing HT?

Unfortunately, there are no approved guidelines for this from the Indian Medical Council. There are also no medical colleges to teach this technique or degrees in HT. Hence this has lead to a confusing situation. Currently, the syllabi of plastic surgeon and dermatology have HT.

In our opinion, training needs to be obtained by working under a reputed hair transplant surgeon who performs at least 15 cases per month for periods of 1-3-6 months(depending on the background of the doctor). Training can also be gained in addition to this in workshops and conferences.

In view of this, the following need to be checked while assessing a surgeon:

Workshops and courses, conferences attended in India and abroad.

Training imparted to people by the surgeon at the trainee’s center.

In addition, experience gained by the surgeon is equally important and this can be assessed by:

Years of practice in HT

No. of cases done over the years

Memberships in associations

Lectures given at conferences

Papers, articles, and books published

Conducting workshops and courses

Positions held in associations in India and abroad

Patients are advised not to go by exaggerated claims such as “The first”, “The best”, “The only”, FDA approved – etc, but look at evidence dispassionately.

At our center, Dr Venkataram Mysore is one of the pioneers in HT, founder and president 2013-14 of Association of Hair Restoration Surgeons, Honorary Fellow of International society of hair restoration surgeons(an honour given only to senior and reputed HT surgeons), on the committees of ISHRS, conducted several workshops , delivered scores of lectures, published several papers, and trained a large number of trainees at his centre. He is also the author and editor of the major book on Hair transplantation in India. Dr Aniketh has learned HT from Dr. Venkat extensively, has contributed chapters in books and has special expertise in FUE.

Where can the surgery be performed?

It is unfortunate that HT surgeries are being performed in Spas, Beauty Clinics, salons, outpatient clinics etc. Patients shouldn’t choose such places simply for reasons of lower cost. Beauty should never come at the cost of life. There have been cases of botched HT surgeries resulting in death of the patients. So, DON’T take it lightly!!

HT is a simple surgery under local anesthesia- so it does not need a hospital major theatre; A day case theater is sufficient. However, it is still a surgery, so all protocols are to be maintained by the Center. These include:

Proper hygiene, sterilization, and disinfection

Well-qualified nurse to carry out these

Proper theater for day case surgeries

Emergency equipment for resuscitation such as emergency trolley, oxygen cylinder, ambulance bag, pulse and respiratory monitor, defibrillator, etc. A person trained in resuscitation should be available during the surgery throughout the surgery.

At our center, we have a dedicated OT and dissection room- which is not used for any other procedure other than surgery. We have all equipment for patient care and safety as found in a major theatre. We have strict protocols for sterilization and disinfection by specially trained OT nurses.

What should the patient insist on?

Patients are often confused by claims and counterclaims, variations in costs etc. We have seen patients who have undergone surgeries, but don’t have even a discharge slip- they are not even aware how many grafts have been placed!!!

Every patient should insist on the following:

Estimate of the number of grafts(units)- NOT HAIRS. HT IS ALWAYS DONE IN GRAFTS, NOT HAIRS

Pre-operative and post-operative instruction sheets

Discharge slip after surgery signed by the surgeon showing precise number of grafts that were planted and the technique

COSTS: How is it calculated?

Patients are often confused by variations in costs from clinic to clinic. Cost has varied from ₹10 or ₹15 per graft to ₹90 per graft. Cost of transplantation varies from patient to patient, technique and experience of the doctor. Visit our center to get an analysis and estimate.

There are several factors which decide final cost:

The area of baldness and the number of grafts – larger the area , higher the number of grafts and more the cost. Small areas and small sessions obviously cost less than large areas and large sessions

Method used– FUT is cheaper than FUE

Experience and expertise of the surgeon– Surgery is art – a surgeon is an artist. A MF Hussain painting costs more than a junior artist!! Likewise, a fresh beginner doctor will be cheaper than a reputed expert.

Place and infrastructure– A place which performs surgery in a clinic will be cheaper than the one done in a dedicated theater as OT expenses are more.

City– Some cities such as Delhi and Mumbai are more expensive because of higher infrastructure costs.

There has to be proper case selection based on detailed history, personal examination and pre-operative assessment with blood tests, ECG to identify underlying medical conditions.

Patients responsibility: The lure of beauty is becoming too hard to resist- patients often insist on HT even when they don’t need it- they are averse to taking medicines and think HT will solve their problems, real or imaginary. They should read and understand the problem, have realistic expectations of what can be achieved, realize that baldness is a progressive condition- it is important to maintain existing hairs by taking drugs in addition to getting new hairs by transplantation. Hair loss needs a combination of treatments; drugs to preserve and surgery to get new hairs. Drugs are underplayed so that patients will come for a second session. ALWAYS UNDERSTAND VALUE OF PRESCRIBED DRUGS.

Commercialization of the practice: A number of non-medical people have entered into hair restoration practice as a business proposition and opened centres/even chain of centres with fancy names, swanky decorated venues, with exaggerated and frequent advertisements claiming unrealistic results- some examples; unlimited grafts, full head, guaranteed results, scarless surgery, etc. DO NOT go by Advertisements or Claims. Likewise, there is a tendency to sell FUE over FUT as FUE earns more revenue for the clinics.

About The Doctor

Dr. Venkataram Mysore was one of the first surgeons to learn this technique in the country. He is an expert in FUT and is one of the most respected Hair Transplant experts in the world. He has edited the first Indian textbook on the subject and is the first and only Indian Dermatologist to be made a fellow of the International Society of Hair Restoration Surgeons.

Dr. Venkataram Mysore, MBBS. DVD. DNB. M.D. DipRCPath (LOND) FRCP(Glasgow), was one of the first surgeons to learn hair transplantation in India. He is an expert in FUT and is one of the most respected Hair Transplant experts in the world. He has edited the first Indian textbook on the subject and is the first and only Indian Dermatologist to be made a fellow of the International Society of Hair Restoration Surgeons.